Month: September 2018

Addiction Nature versus Nurture –Which? Both?

Sep 1, 2018

By TERRY M BENNETT, MD

For those of you who missed the first essay in this series, on the genetics of addiction, in all of us there is a genetic code, a code, which along with billions of other variations , contains a fairly common single gene genetic variation , the Folic Acid ( Vitamin B9) transport gene, which we can test for, using a cheek swab.

This deficient/diminished Folic Acid transport gene variation, present in many of us, slows or halts the transport of folic acid into our brains, predisposing us to lifetime depression and , in many cases, into early drug or alcohol experimentation, in an attempt to “feel better”. Why?

Folic acid is required by the brain in order to construct the neurotransmitter substances; Dopamine, Norepinephrine, and Seratonin. So, too little or no Folic acid present ,and too little or no brain neurotransmitters get constructed, and the patient’s darkened mood reflects that lack. Experimentation often follows early and often in such patients’ lives.
As most of you know, I run a Suboxone Clinic as well as a standard general practice, and I have yet to discover a Suboxone Clinic patient who transports Folic Acid normally from blood stream into their brain.

Spring Training for Health Care Teams

Sep 1, 2018

By Thomas H. Lee, MD

Two years ago, I wrote a piece in HBR called “Turning Doctors into Leaders,” which began with the sentence “The problem with health care is people like me” — that is, physicians who had been trained in an era when excellence in medicine was defined by what you did as an individual. In the short period since, the concept that medicine is actually a team sport has become increasingly accepted. Because of medical progress, there is too much to know, too much to do, and too many people involved to give patients excellent care, unless we get better at working in teams. A lot better.

Sounds good — but it’s a lot easier to write or talk about than to do. In fact, organization and collaboration are unnatural acts in much of medicine, where payment is still fee-for-service and the culture of individualism still dominates. Progress is being made — more in some regions and at some delivery systems than others. In this post, I will assess that progress by giving grades in various key functional areas akin to those that sportswriters are currently giving baseball teams as they get ready to break spring training. Like those sportswriters, I will try to blend optimism and realism.

Ability to put a team on the field — C. The payment system actually is changing, and ambitious pilots like Medicare’s Accountable Care Organization contracts are underway. In these new contracts, providers share heavily in savings and losses. And, as a provider, I can tell you that we really hate to lose (i.e., bear financial losses for care we have given).

E-Prescribing: Experiences from Physician Practices and Pharmacies

Sep 1, 2018

By Teresa Zayas-Cabán

The May 2012 edition of the Journal of the American Medical Informatics Association (JAMIA) offers the opportunity for a second look at an important recent study on e-prescribing. The study, “Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies,” examines practitioners’ experiences with this potentially game-changing technology.

The study, first available on the AMIA web site in November 2011, is now one of 12 articles included in the JAMIA issue on the “Focus on health information technology, electronic health records and their financial impact.” (It is available at no cost at http://jamia.bmj.com/content/current.) In the article, Joy M. Grossman, PhD, and colleagues from the Center for Studying Health System Change (HSC) conducted a qualitative analysis of 114 telephone interviews with representatives from 97 organizations including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions. This study is part of a larger qualitative project on e-prescribing. An earlier publication, released in May 2011, explored physician practice use of e-prescribing to access external information on patient medication histories, formularies and generic alternatives. It can be found at http://www.hschange.org/CONTENT/1202/.

The (Affordable!) Health Coach in Your Pocket

Sep 1, 2018

By Kim Krueger

Vida, a new health coaching app that connects users to coaches and educators for $15/week, launched commercially this week with $5 million in funding from Khosla Ventures and several others, as well as an on stage demo at Code Mobile.

Vida is the latest in a crop of health apps focused on tech-enabled services. The idea is a familiar one at this point, but something that health care has struggled with: how can we keep individuals with chronic illnesses on track between doctor’s appointments? The answer has historically required high-cost, high-touch programs, but now technology is helping those programs scale.

Founder and CEO Stephanie Tilenius and Chief Medical Officer Connie Chen sat down with Matthew Holt to explain how Vida works, how it’s currently being used, and what’s on the road map for the young, San Francisco-based company.

Kim Krueger is a Research Analyst at Health 2.0.

Matthew Holt Interviews Regina Holliday at HIMSS

Sep 1, 2018

By PRIYA KUMAR

Another in a series of interviews that should have been posted months ago, but Matthew Holt is just getting to now.

If you don’t Regina Holliday, well you should. Regina is a patient rights activist and artist, and she founded The Walking Gallery of Healthcare in 2009 after attending her first medical conference. We are also pretty sure that Health 2.0, in 2010, was the first conference she was invited to speak at! She is on a mission to amplify patients’ voice by painting jackets for patients and providers.

Several companies and individuals are now asking Regina Holliday to paint their story. Today, The Walking Gallery has a total of 43 artists and 400+ painted jackets. Individuals who believe in the movement are asked to join Regina at Salt and Pepper Studios in Maryland, and are able to paint their patient narrative. Matthew Holt caught up with Regina at HIMSS back in February, where her painting was sponsored by Xerox Health for the first time at the conference. A very interesting woman with a different approach to supporting patient rights.

Priya Kumar is an Operations & Marketing Intern at Health 2.0, and a student at the George Washington University

Income Taxes and Healthcare: The Disconnect

Sep 1, 2018

By PAUL KECKLEY

After leaving Navigant in February, my pondering of ‘what’s next’ was interrupted by the reality of income taxes due weeks later. By midnight tonight, 240 million Americans will have filed, 53% will have paid something to Uncle Sam and all of us will be puzzled by where it goes and how it’s used.

Our federal individual taxes provide 47% of the federal government’s revenues, or $1.48 trillion for FY15. Payroll taxes paid jointly by workers and employers make up another 34%, or $1.07 trillion and corporate taxes 11%, or $342 billion.

The federal government will spend more than it receives: for FY2015 just ended, federal receipts from all sources were $3.25 trillion and expenditures were $3.68 trillion billion. And 25% of that went to Medicare and the federal its portion of the CHIP and Medicaid programs.

Healthcare makes up the biggest chunk of Treasury spending followed by Social Security (24%), Defense (16%), and a bucket of expenditures called Discretionary Spending (16%) over which Congress exercises its influence most directly. And when Defense spending for healthcare is added ($51 billion annually), the state portions of Medicaid and CHIP payments are added, and health coverage for federal employees are added, more than 30% of the federal spending goes to healthcare. So one might reason that if individual income taxes are 47% of total federal receipts, income taxes paid for more than $500 billion of the healthcare tab. But that’s not widely known or understood by taxpayers nor is it a complete picture.

150 Ways to Measure Healthcare Quality. Which One is Best?

Sep 1, 2018

By TOM EMERICK and DAVID TOOMEY

In a previous article, we referenced CMS’s new provider reimbursement model, called Medicare Access and CHIP Reauthorization (MACRA), which replaces the current reimbursement formula. MACRA will include an incentive component that will replace the incentive programs in plans today, and the details of the performance criteria are being determined for roll-out in 2019. From the providers’ lens, they are faced with the need to hire more administrative resources to keep up with the tracking of their performance, and the big question is – are consumers making different choices based on the performance results of a physician or hospital? When there are over 150 different measures in place today, how is an occasional consumer of healthcare services able to assess the most important criteria in finding the right physician?

During a recent employers’ conference on the east coast, the forum featured two panels consisting of the healthplans and the providers. The panels were set in a Q&A format to enlist the leaderships’ views on various topics facing the employers, and it was a fascinating dialogue that we have attempted to capture below.

In the first panel with the execs of five major carriers, the opening question asked for a one minute overview of their healthplan’s area of focus in addressing the employers’ challenges. The responses were consistent amongst the leaders – the focus is on the individual consumer and value-based contracting. When we evolved the discussion into quality criteria and outcomes to identify high performing physicians, the leaders acknowledged that defining quality and outcomes is a challenging endeavor, and each health plan has their own formula to assess the providers’ performance. One commented that a physician practicing in the morning could be viewed as a top performer by a carrier, while that afternoon, they could be ranked as a poor performer by another, even though the physician was delivering the same process of care for all their patients. They agreed that the employers really needed to weigh in on what was important to them, so there was greater consistency in the scoring logic with the physician community.

Measurement of Interoperability and the Transaction Receipt

Sep 1, 2018

By ADRIAN GROPPER, MD

Our aptly named Office of the National Coordinator needs your help. Congress wants to know if the regulations are working to enable interoperability and reduce information blocking. So, ONC wants us to “Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability” and has produced a helpful 19-page description of the issue. This interesting issue also made it to last week’s most august Joint HIT Committee for some lively discussion.

The only reasonable way to measure something is to consider the denominator as well as a numerator. Without the denominator to indicate the scope of what’s being measured, the numerator is likely to be misleading. With respect to interoperability, the denominator is simply all transactions that move individual-level patient data in or out of an institution.

Data moves in or out of an institution for different reasons and in different ways. The reasons include HIPAA Treatment, Payment, or Operations (TPO), to business associates, under patient authorization (regardless of whether it’s opt-in or opt-out), for research (e.g.: the Precision Medicine Initiative), and de-identified (to various data brokers and analytics services).

The ways that individual-level data moves is via analog fax, paper and film, digital media, or digital network. Measurement of interoperability would do well to consider all of these transports as part of the denominator.

We can define a data sharing transaction and hopefully allow a patient to request notification of that transaction. As individuals, we expect an accounting for data movement from our banks, email, and package services and we should expect the same for our health records. Specifically, I would define the following essential elements of a personal health data transaction:

Transaction Receipt and Notification

Resource (medication, problem, demographic, note, order, etc…HL7 coded, if possible)
Transport (fax, paper, film, digital device, digital network)
Client / Requesting Party (by institution, app, or individual name)
Date /Time (for any single client or requesting party, a monthly notice might be sufficient)
API Class (is the specific Resource also available through a patient-directed interface?)
Fee (who paid how much for this transaction or a link to the appropriate contract)

For a description of the API Class see https://thehealthcareblog.com/blog/2016/02/22/apple-and-the-3-kinds-of-privacy-policies/

Establishing the denominator from the transaction receipt perspective works whether or not an individual patient chooses to supply an email address for notification. The mere fact that such a notification is available improves transparency, cybersecurity, and trust.

As Bob Wachter has said, http://www.clinical-innovation.com/topics/analytics-quality/wachter-transparency-inexpensive-and-effective-tool transparency is an essential step to health system improvement. Let’s start with a transaction receipt and notification whenever our personal data is shared.